2021 Volume 57 Issue 6 Pages 1012-1015
We report the case of a girl with biliary atresia. Portoenterostomy was performed at 57 days of age. The portal vein seemed to show trifurcation with division of the main portal vein into the left, right anterior and right posterior. The main fibrous cone was normally attached to the middle portion of the portal fissure between the left portal branch and the right anterior branch, but fibrous tissue to the posterior segment branched off early from the main fibrous cord and ran along the right posterior portal vein. It was as if the south-turning right posterior bile duct became a fibrous cord. The fibrous cone on the hepatic hilum between the left portal branch and the right anterior branch was dissected and transected at the level immediately outside of the liver capsule. The fibrous tissue running to the posterior segment was also transected at the level immediately outside of the liver capsule of the medial portion of the right posterior portal vein. Two small incisions were made on the antimesenteric border of the roux limb of the jejunum. Two anastomoses were also performed to cover the surface of the transected tissue between the left portal branch and the right anterior branch and between the right anterior branch and the right posterior branch. Her jaundice resolved promptly. Although it is a short-term follow-up result, her postoperative course has been good. Portoenterostomy with double anastomoses can be an option in cases of biliary atresia with anatomical variance in portal structures.
